Pediatric Dysfuntional Elimination

Dysfunctional Elimination in children occurs when the pelvic floor muscles (PFM) are not working together with the bladder and /or bowel, and the normal voiding or emptying reflexes can be disrupted. This can cause a chronic abnormal pattern of elimination which does not allow the bladder or bowel to empty completely. Some children experience difficulty urinating or controlling their bladder function, frequent bladder infections, constipation, not urinating enough during the day, or sensing bladder fullness. Children may periodically have leakage during the day or wake up wet in the morning or both. This can be embarrassing and uncomfortable. If you child has experienced any of the above symptoms they may have been seen by a physician or specialist, who is now recommending therapy to relax and retrain the pelvic floor muscles.

How can therapy help your child? Some children do not completely empty their bladders and there is some urine left in the bladder. This is called a Post Void Residual (PVR). One reason this happens is the pelvic floor muscles are not relaxing throughout the entire urination. A post void residual can be attained with an ultrasound test which uses an ultrasound head placed over the lower abdomen. It takes pictures of the bladder after your child has urinated. It can tell how much urine is left in the bladder after they go to the bathroom. Therapy can give you the tools that your child and family need to take control of their bladder and bowel functions. When working correctly the bladder and pelvic floor muscles work opposite each other to urinate properly. The walls of the bladder are made of muscle and contract to urinate. The pelvic floor muscles relax when the bladder contracts or the bowels empty. Your child will learn exercises to relax and strengthen the pelvic floor muscles at the appropriate time, void and empty completely, and avoid urinary and/or bowel leakage.

Animated surface biofeedback may also be used to teach your child how to relax the pelvic floor muscles while emptying the bladder or bowel and strengthen the muscles in between urination. He or she will have a home exercise program emphasizing his or her responsibility for and independence with completing these daily. Your child will learn the correct postures for toileting, foods that can be irritating to the bladder, and learn to sense bladder fullness through a toileting schedule that creates regular patterns of filling and emptying. Therapy can help you child achieve dry days and nights.

What should I expect my first visit? On the first visit we will need information from you to make sure you get the best possible care. A patient information packet should be completed and given to our staff when you check in for the first appointment. This packet will provide you with a description of the first evaluation and other treatments as well as a patient history form. The packet will have a bladder diary form that needs to be filled in about your child’s food and fluid intake as well as voiding habits and brought with you the first visit. It is a very important part of the first visit and gives valuable information. You can download this packet here or call (217) 876-2600 to have it mailed to your house. The first visit takes about 1hour and will include the initial evaluation. The initial evaluation will include discussion with you and your child about the previously completed questionnaires, the bladder log and the medical history. A treatment program is started the first visit including child/family education.

Where do we go from there? Once the therapist has finished the evaluation, they will share their findings and give an idea about total number of treatment sessions and frequency. Children are seen an average of 6-8 visits for approximately 30 minutes. Each treatment plan is formed from the exam results and different patients require different amounts of time. It is very important for the child to be actively involved in their care. A cooperative effort between parental supervision of home exercises needs to be balanced with the child being accountable for their own exercises and filling out bladder and bowel charts. This will ensure the best possible results.

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